Injectable Fillers: Principles and Practice

195 Pages·2010·8.17 MB·English

by  Derek Jones

Injectable Fillers:
Principles and
Practice
EDITED BY
Derek Jones, MD
Clinical Associate Professor, Department of Medicine, Division of Dermatology,
David Geffen School of Medicine, University of California at Los Angeles
A John Wiley & Sons, Ltd., Publication

Injectable Fillers:
Principles and
Practice
Companion – CD-ROM
This book is accompanied by video of procedures described in the text:
(cid:129) Radiesse and Evolence Breeze
for augmentation of the
cheeks, oral commissures,
lateral brow, nasolabial fold
and lips
Injector: Jean Carruthers, MD
(cid:129) Hyaluronic Acid: Juvederm
Ultra and Ultra Plus for
augmentation of the nasolabial
folds, oral commissures, labial
mental groove, and lips
Injector: Derek Jones, MD
(cid:129) Sculptra for treatment of facial
lipoatrophy (non-HIV)
Injector: Derek Jones, MD
(cid:129) Liquid Injectable Silicone
(Silikon-1000) for treatment of
HIV-associated facial
lipoatrophy
Injector: Derek Jones, MD
Total running time: 50 minutes
Injectable Fillers:
Principles and
Practice
EDITED BY
Derek Jones, MD
Clinical Associate Professor, Department of Medicine, Division of Dermatology,
David Geffen School of Medicine, University of California at Los Angeles
A John Wiley & Sons, Ltd., Publication
This edition fi rst published 2010, © 2010 by Blackwell Publishing Ltd
Blackwell Publishing was acquired by John Wiley & Sons in February 2007. Blackwell’s publishing
program has been merged with Wiley’s global Scientifi c, Technical and Medical business to form
Wiley-Blackwell.
Registered offi ce: John Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex,
PO19 8SQ, UK
Editorial offi ces: 9600 Garsington Road, Oxford, OX4 2DQ, UK
The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK
111 River Street, Hoboken, NJ 07030-5774, USA
For details of our global editorial offi ces, for customer services and for information about how to
apply for permission to reuse the copyright material in this book please see our website at www.
wiley.com/wiley-blackwell
The right of the author to be identifi ed as the author of this work has been asserted in accordance
with the Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or
transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or
otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the
prior permission of the publisher.
Wiley also publishes its books in a variety of electronic formats. Some content that appears in
print may not be available in electronic books.
Designations used by companies to distinguish their products are often claimed as trademarks. All
brand names and product names used in this book are trade names, service marks, trademarks or
registered trademarks of their respective owners. The publisher is not associated with any product
or vendor mentioned in this book. This publication is designed to provide accurate and
authoritative information in regard to the subject matter covered. It is sold on the understanding
that the publisher is not engaged in rendering professional services. If professional advice or other
expert assistance is required, the services of a competent professional should be sought.
The contents of this work are intended to further general scientifi c research, understanding, and
discussion only and are not intended and should not be relied upon as recommending or
promoting a specifi c method, diagnosis, or treatment by physicians for any particular patient. The
publisher and the author make no representations or warranties with respect to the accuracy or
completeness of the contents of this work and specifi cally disclaim all warranties, including
without limitation any implied warranties of fi tness for a particular purpose. In view of ongoing
research, equipment modifi cations, changes in governmental regulations, and the constant fl ow of
information relating to the use of medicines, equipment, and devices, the reader is urged to
review and evaluate the information provided in the package insert or instructions for each
medicine, equipment, or device for, among other things, any changes in the instructions or
indication of usage and for added warnings and precautions. Readers should consult with a
specialist where appropriate. The fact that an organization or Website is referred to in this work as
a citation and/or a potential source of further information does not mean that the author or the
publisher endorses the information the organization or Website may provide or recommendations
it may make. Further, readers should be aware that Internet Websites listed in this work may
have changed or disappeared between when this work was written and when it is read. No
warranty may be created or extended by any promotional statements for this work. Neither the
publisher nor the author shall be liable for any damages arising herefrom.
Library of Congress Cataloging-in-Publication Data
Injectable fi llers : principles and practice / [edited by] Derek Jones.
p. ; cm.
Includes bibliographical references.
ISBN 978-1-4051-9289-7
1. Tissue expansion. 2. Fillers (Materials) 3. Surgery, Plastic. 4. Face–Surgery.
I. Jones, Derek, 1965-
[DNLM: 1. Face. 2. Cosmetic Techniques. 3. Dermatologic Agents.
4. Injections. 5. Rejuvenation. WE 705 I505 2010]
RD119.5.T57I55 2010
617.9′52–dc22
2009030111
ISBN: 9781405192897
A catalogue record for this book is available from the British Library.
Set in 9.5 on 13 pt Meridien by Toppan Best-set Premedia Limited
Printed in Singapore
1st impression 2010
Contents
Preface, vi
Contributors, viii
1 The Cosmetic Patient Consultation, 1
Phil Werschler
2 Guidelines for Local Anesthesia in Use of Injectable Fillers, 8
Mariano Busso
3 Hyaluronic Acids: Basic Science, 19
Nowell Solish and Kenneth Beer
4 Calcium Hydroxylapatite Microspheres in Facial Augmentation, 27
Alastair Carruthers and Jean Carruthers
5 Evolence and Evolence Breeze, 43
Jean Carruthers and Alastair Carruthers
6 Poly-L-Lactic Acid, 54
Rebecca Fitzgerald and Danny Vleggaar
7 Liquid Injectable Silicone, 75
Chad L. Prather
8 Hydrogel Polymers, 91
Naissan O. Wesley
9 Artefi ll: the First to Last, 103
Adam M. Rotunda and Rhoda S. Narins
10 Complications from Soft-Tissue Augmentation of the Face:
A Guide to Understanding, Avoiding, and Managing
Periprocedural Issues, 121
Marc D. Glashofer and Joel L. Cohen
11 The Mathematics of Facial Beauty: A Cheek Enhancement Guide
for the Aesthetic Injector, 140
Arthur Swift
12 Hyaluronic Acids: Clinical Applications, 158
Derek Jones and Timothy C. Flynn
Index, 175
“This book is accompanied by a CD-ROM with videos
showing procedures described in the book.”
v
Preface
Since the Food and Drug Administration (FDA) approval of the fi rst inject-
able hyaluronic acid for correction of facial wrinkles in 2003, there has
been an explosion of natural and synthetic fi llers in the medical cosmetic
market and millions of procedures are now performed annually. At the
time of writing, we currently have 14 injectable devices approved by the
FDA from which to chose: fi ve collagen products of bovine (Zyplast,
Zyderm), porcine (Evolence) or human origin (Cosmoplast, Cosmoderm);
six hyaluronic acid products (Restylane/Perlane, Juv é derm Ultra and
Ultra Plus, Elevess, Prevelle Silk); calcium hydroxylapatite (Radiesse); and
the synthetic poly- L - lactic acid (Sculptra) and the permanent polyme-
thylmethacrylate (Artefi ll). Liquid injectable silicone (Silikon - 1000) is
available only off - label as a permanent injectable fi ller. There is no “ one
best ” fi ller or “o ne right way” to achieve a beautiful and natural result.
Although the hyaluronic acids dominate the marketplace, all of these
fi llers have an important and useful role, and are often used to best effect
in combination.
The goal of this book is to present the basic science, review safety and
effi cacy data that have led to FDA approval, and outline patient selection,
safe, and effective injection techniques, and appropriate indications for
each fi ller. It should be noted that most FDA studies leading to approval
have formally studied most fi llers only in the nasolabial fold. Other indica-
tions that are outlined (such as volumizing the lip and cheek) in this book
are considered “ off - label ” in the USA, meaning that, although it is legal
to inject these areas, the FDA has not reviewed safety or effi cacy data and
granted a formal indication for such use.
Lastly, a procedural DVD, running for about 1 hour, is included with
this book and demonstrates appropriate injection techniques for most of
the fi llers discussed. When assessing volume loss in the face, the physician
will do best to not concentrate only on one area (such as the nasolabial
fold) as a discrete entity, but assess multiple areas of volume loss (lips,
cheeks, oral commissures) in relationship to each other and tailor the
treatment plan accordingly. A great deal of effort has been put in to teach
the reader how to avoid complications and, when they may occasionally
vi
Preface vii
happen, how to properly identify and treat them. The novice should thor-
oughly master the anatomy of the skin and subcutaneous tissue of the
face, including vascular, muscular, and neural structures, before starting
actual injections. In general when injecting, I advocate a very slow, steady,
and deliberate injection technique with absolute attention given to the
correct plane of injection (intradermal, subcutaneous, epiperiosteal),
which is different for each fi ller and is crucial to achieving a good result.
Derek Jones